What is a Breast Reduction (Bilateral Reduction Mammaplasty)?

A breast reduction, also known as “bilateral reduction mammaplasty”, is designed to relieve symptoms from excessive breast size and weight, known as symptomatic “macromastia”.

During a breast reduction, excess skin, breast tissue and fat is removed, the nipple and areola are lifted to a higher position on the breast, and the areola size is usually reduced. A breast lift is always incorporated into a reduction to ensure that you are not only smaller, but perkier-breasted!

Dr. Horton performs an “auto-augmentation” technique for all her breast reductions and lifts that reshapes the breasts in addition to making them smaller and moves the breast tissue higher up on the chest wall.  Liposuction is also added to reduce unwanted fat in the armpit region, known as the “axillary roll” and the sides of the breast and upper back (the “bra roll”).

Symptoms of macromastia are often relieved immediately upon wakening!  Surgery generally takes three hours and is usually done in an outpatient setting.  After a breast reduction, a woman’s breasts will be more proportional to the rest of her body, clothes will fit better, and many women are able to become more physically active and to achieve their personal fitness or weight-loss goals.

Breast reduction has tremendous psychological benefits as well. It truly is a procedure whose outcome improves quality of life of patients! Many studies have shown that reduction mammaplasty is the number one most satisfying procedure that the specialty Plastic Surgery has to offer! Having a breast reduction can be life-changing for many women.

Who is a Good Candidate for a Breast Reduction?

Many women feel their breasts are too large for their frame, that their breasts are out of proportion to their body, or they may feel embarrassed about their large breast size. They have heavy, pendulous breasts with nipples and areolas that point downward (known as breast and nipple “ptosis”), or they may have one breast that is much larger than the other.

Good candidates for a breast reduction include women who are healthy, in good physical shape, and as close as possible to their ideal body weight (or a stable weight after major weight loss). You should not be obese (body mass index or BMI above 30), as an increased body mass index raises your risk of complications.

Women seeking reduction mammaplasty have typical signs and symptoms of macromastia:

• Breast pain
• Back pain
• Shoulder pain
• Shoulder grooving from bra straps
• Rashes beneath the breasts (“intertrigo”)
• Poor posture
• Difficulty doing sports or physical activities
• Self-consciousness about breast size
• Difficulty fitting into clothing

Is a Breast Reduction Part of a Mommy Makeover?

Breast reduction is a common component of Mommy Makeover surgery! Please see our Mommy Makeover section to learn about changes that commonly occur in the breasts, the tummy and other areas of your body after pregnancy, and about breast reduction as a component of a Mommy Makeover.

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What Are The Different Methods of Breast Reduction?

The enlarged breast has three or four issues: (1) there is an excess of breast tissue and fat which is heavy, droopy and creates the symptoms of hypermastia, (2) an enlarged or stretched-out nipple and areola sits low on the breast, often pointing downwards, (3) there is an excess of breast skin, and often (4) there is an overabundance of fatty tissue in the “axillary” (arm pit) area and around the side of the breast, extending toward the back, creating a “bra roll” of back fat.

A breast reduction therefore involves three or four separate but intimately related components:

1. Reducing the overall breast volume and reshaping the breast tissue,
2. Reducing and repositioning the nipple to a more youthful position on the breast,
3. Removing and redraping extra skin and
4. De-fatting the axillary and lateral breast regions to create the best possible contour to the breast.

Breast reduction truly is a Three-Dimensional Operation: the underlying breast tissue is reduced and reshaped to create a smaller, more compact and perky breast, while the overlying skin is redraped around the breast to reduce the “skin envelope”. Because a breast reduction includes reducing the breast in the horizontal dimension (lifting upward) and the vertical dimension (narrowing a wide breast), the incisions used are also three-dimensional and include both vertical and horizontal lines in addition to a circular incision around the nipple. Scar length is always minimized as much as possible.

Superomedial Pedicle Technique

The most common procedure we use for breast reduction involves a circular incision around the areola, a vertical incision from the areola down to the inframammary fold (IMF), and a short scar that lies within the IMF. These incisions are shorter than the traditional “anchor scar” that is commonly described for breast reductions.

The circular areolar incision allows the nipple to be repositioned on the breast and the areolar diameter to be reduced as necessary. Structures leading to the nipple such as sensory nerves, blood vessels and milk ducts are preserved as much as possible. The various techniques of reduction include additional incisions based on the degree of hypermastia, the shape of the breast, the degree of skin excess and nipple ptosis.

The “superomedial pedicle” refers to the direction from which blood supply, nerves and milk ducts to the nipple are preserved. In this technique, breast tissue, skin and fat are removed from the bottom and sides of the breast only. Fullness is preserved in the upper (“superior”) and inner (medial”) parts of the breast, where cleavage is desired. The pedicle that contains structures leading to the nipple is rotated to a higher position on the breast. The inner and outer regions of the breast are reshaped to create a perkier and more compact breast shape, and the skin is redraped to complete the procedure.

The superomedial pedicle breast reduction technique creates the perkiest shape possible. The inframammary scar is hidden when viewing the breasts from above or from the front, it is usually concealed in bras and bikini tops, and is generally only visible on careful inspection up close when the breasts are lifted. The vertical incision generally fades to be nearly imperceptible, and the areolar scar lies and the natural junction of the pigmented areola and surrounding breast skin.

“Lollipop” Scar Technique

For breasts with a minimum of skin redundancy and only mild nipple droop, the “lollipop technique” can be used. This method creates the periareolar and vertical incisions only, without the horizontal inframammary scar. The nipple blood supply, nerve supply and ductal supply is maintained, like in the inverted T technique. This technique is not appropriate for extremely droopy breasts or those with a significant amount of extra skin, where a true three-dimensional reduction of the breast envelope is required.

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What Are Potential Risks and Complications of Breast Reduction?

Please see our Preparing for Surgery section to learn about risks and potential complications related to surgery and Postoperative Instructions for Breast Surgery for additional information pertaining to breast reduction.

Will a Breast Reduction Interfere with Breast Function?

All breast procedures should ideally preserve the two major functions of the breast: (1) breastfeeding ability and (2) erogneous sensation to the nipple.

During a breast reduction, some breast tissue is removed, usually from the bottom and the sides of the breast where it is not as important. Vital anatomic structures of the breast (milk ducts, sensory nerves and blood vessels) are preserved as much as possible. The remaining breast tissue is then rearranged with the goal of reshaping the breast in its smaller and lifted form while maintaining breast function.

An “auto-augmentation” involves dissecting a “pocket” or space at the upper pole of the breast and rotating the nipple, areola and upper breast tissue into this space.  This is the space where a breast implant is placed to increase upper pole fullness.  The sides of the breasts are brought together to narrow the breast base, and liposuction debulks unwanted fullness from the armpits and the sides of the breasts (known as the axillary rolls) and the annoying fat roll under the fold of the breast as well.

As long as some milk ducts that lead to the nipple are preserved, the possibility of being able to breast feed is promoted. Trying to nurse your baby after breast surgery is always encouraged. Unfortunately, some women may be unable to breast feed even without having breast surgery. Keep in mind that supplementation with formula may be required if you do not produce a large volume of breast milk in any situation.

After reduction mammaplasty, sensation should slowly return to the nipples, but may never return to normal. Nerve recovery can take from many months up to a year or more to recover.

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What Really Happens During Breast Reduction Surgery?

Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery.

Dr. Horton performs the “superomedial pedicle” technique for the vast majority of patients.  In this technique, an incision is made around the nipple and areola, and excess skin is removed. The blood supply is perserved coming from the superomedial portion of the breast (the upper and middle quadrant, closest to the sternum).

Excess breast tissue is removed from the bottom part of the breast and the sides. The goal is to remove enough breast tissue to make a major difference to a woman’s symptoms of macromastia, but to keep her proportional to the rest of her body.  Breast reduction surgery is really “designer surgery” – we can do almost anything!  We use “wish pictures” (see below) to help plan the very best surgical technique for each patient, individually.

Following breast tissue removal (which is sent to Pathology for analysis), the remaining breast tissue is rearranged three-dimensionally to reshape the breast into a perky, more youthful contour via the “auto-augmentation” method described above. The “pedicle” which contains the structures leading to the nipple is rotated to its new location, maintaining attachments to the rest of the breast. The remaining breast skin is redraped around the new breast shape to complete the procedure.

Breast tissue removed during surgery is sent to the Pathology Lab for routine examination (where breast tissue is stained and the cells are evaluated under the microscope). Although we expect the results to be normal, it is prudent to have breast tissue evaluated and to receive a formal report. Drains are very rarely used for a breast reduction (unlike a breast augmentation), as there is no foreign body (no breast implant) and the empty space resulting from breast tissue removal is filled via the auto-augmentation.

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Is Liposuction Part of a Breast Reduction?

Liposuction is always added to a breast reduction to further contour and debulk the outer part of the breast (the “bra roll” area that extends from the side of the breast around to the back) and the “axillary roll” area (arm pit fat).

While liposuction can reduce the overall volume of the breasts by removing most fat, using this method alone does not reshape the breast or redrape excess skin, nor does it lift the nipples. For this reason, liposuction is used more as an adjunctive procedure to breast reduction, rather than as the primary method of reducing the breasts.

While the main objective of breast reduction is to alleviate symptoms of macromastia, the final result should LOOK as beautiful as possible, with the very best aesthetic result! The use of liposuction helps to minimize scar length and provide an aesthetic contour to the breast, avoiding long scars and/or a residual back fat roll.

Where Can I See Before and After Photographs of Breast Reduction Procedures?

Visit our photo gallery to see before and after breast reduction results!

Is Breast Reduction Surgery Covered by Insurance?

A breast reduction is often considered cosmetic, particularly if it is being done solely to improve the appearance of the breasts. However, if signs of symptoms of macromastia are present, it may be covered in part or completely by insurance.  Dr. Horton is no longer a participating provider for any insurance plans.  However, our office may be able to assist with out-of-network billing.  Mary Pasache can answer additional questions about this.

How Do I Best Plan for my Breast Reduction?

In preparation for a breast reduction (or any type of breast surgery including a breast augmentation, lift or revision surgery), we recommend that patients find some “wish pictures”.  A good place to start might be our website before and after gallery.  Wish pictures should be in two categories:  YES images and NO images.

YES pictures should reflect a woman’s body type, proportions and curves, and should show us how they would like their breasts to look.  If images are found from another surgeon’s website, pay no attention to what cup size is listed – we focus more on shape, aesthetics, proportion and projection than a letter (B, C, D, DD etc).   A Google image search may also help find images of breasts that a woman likes.

NO pictures are usually obvious – we would never create a breast that was out of proportion to a woman’s body or were aesthetically unappealing.  The NO images are more for our patients than for us! (so they know what they are not going for with their surgery).  However, they are useful to help educate about what surgery will achieve and what it cannot.

Is There Anything Else I Should Know About Breast Reduction Surgery?

A breast reduction is a wonderful procedure, and most women wake up to immediate relief of their symptoms and remark “why did I wait so long?”! However, it is important to know that your body image will undergo adjustment. Body image adjustment is a very common and normal experience that many women go through after breast reduction surgery.

You may have been thinking about having a breast reduction for a long time, in many cases, several decades! Once you finally undergo surgery, you wake up and your body has changed significantly in the blink of an eye. Although the change is entirely positive and your symptoms of macromastia are alleviated, it can take some time for your brain to adjust to the “new normal”.

Remember that breast reduction surgery has the highest satisfaction of all procedures offered in Plastic Surgery. Rest assured that any feelings of being “out of sorts” or feeling emotional will pass as you recuperate and get used to the new you!

Will I Need Additional Surgery after a Breast Reduction?

The results of a breast reduction are permanent, and your breasts will remain perky with their new smaller size and attractive shape for many years. However, your breasts will age with you over time, as appropriate. Your surgeon will follow up with you and ensure that your breasts still look fabulous for many years after your surgery. There is no reason to undergo any additional surgery unless you are experiencing a problem or unless you wish to do so.

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Is There a Minimum or Maximum Age for Breast Reduction?

Breast reduction is a procedure which is done to improve a woman’s quality of life, and therefore can be done at any time, with no age limits. All potential breast reduction patients should fit into the parameters of an appropriate candidate for surgery in general.

For teenagers, a breast reduction can be done to enable a young woman to more easily participate in physical activities, to feel more comfortable about her body and can often improve self-confidence and self-esteem. A breast development history will be taken at her consultation to determine whether her breasts have completed their growth.

It is possible that following a breast reduction in a very young woman, further breast development may occur and the breasts could grow larger than their post-surgical size over time. If this were to occur, a repeat breast reduction could be done if needed. The timing of breast reduction surgery requires judgment about current quality of life, the risks and benefits of surgery and other details that will be discussed fully at your breast reduction consultation.

Likewise, for older women, a breast reduction can significantly improve quality of life and enable many more physical activities, in addition to alleviating physical symptoms of macromastia. “Age is just a number”, and many women in their 60s, 70s and beyond are healthy, active and physically fit, enjoying life as it was meant to be! It is reasonable for an older woman to consider having surgery as long as she is healthy enough to undergo a lengthy procedure under general anesthesia. Your Primary Care Physician may be called upon to clear her medically for surgery, together with any other specialists who are supervising your medical care.

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How Do I Know Whether a Breast Reduction is Right For Me?

At your initial breast reduction consultation, Dr. Horton will spend a great deal of time getting to know you personally and taking a complete medical history. As women Plastic Surgeons, we intimately understand how a woman’s feelings about her breasts can influence her self-image and her femininity, and we aim to help you feel better, move better, and give you the result you are looking for! We will explore your reasons for seeking breast reduction, examine your breasts, and if you are an appropriate candidate for surgery, your options will be described in detail.

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